Too Old for Surgery? Outcomes of Hip Fracture Surgery in Centenarians

Ng, Wei Xiang; Kwek, Ernest Bk

doi:10.47102/annals-acadmedsg.v46n3p115

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…As occurs in younger age groups, surgical treatment of hip fractures has been shown to reduce the risk of mortality in centenarians, compared to those managed non-operatively. 24 In the case of centenarians, we have found that their previous medical condition is a prognostic factor and, therefore, the assessment of surgical risk in this age group becomes even more important. The involvement of geriatricians in this decision-making process is crucial in the very elderly, as is taking into consideration the patient’s rights and wishes.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Studies on hip fractures in centenarians are limited in number of patients and show contradictory results. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Differences have been described in relation to the type of fracture, [2][3][4][5][6][7][8] the relationship between time to surgery and outcomes 5 and the risk of complications during hospitalisation. 9 Discrepancies have also been published regarding short and long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Boixareu¹,

Ojeda-Thies²,

Valtueña³

et al. 2023

CIA

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Objective The primary objective was to describe the clinical characteristics, management, and outcomes of centenarians with fragility hip fracture and compare them to other age groups. The secondary objective was to determine the variables associated with length of stay, in-hospital mortality and 30-day mortality. Materials and Methods This is a secondary analysis of the Spanish National Hip Fracture Registry. We included patients ≥75 years admitted for fragility hip fractures in 86 Spanish hospitals between 2017 and 2019, dividing the sample into four age groups. The variables studied were baseline characteristics, type of fracture, management, length of stay, in-hospital mortality and 30-day mortality. Results We included 25,938 patients (2888 were 75–79 years old; 14,762 octogenarians; 8,035 nonagenarians and 253 centenarians). Of the centenarians, 83% were women, 33% had severe dementia, 9% had severe dependency and 36% lived in residential care homes. Six out of ten had intertrochanteric fracture. Length of hospital stay was 8.6 days; in-hospital mortality was 10.3% and 30-day mortality 20.9%. Older age groups had more women, severe functional dependency, severe dementia, intertrochanteric fracture, living in care facilities and being discharged to nursing care. They had less frequent early mobilization, osteoporosis treatment and discharge to rehabilitation units. In-hospital and 30-day mortality were higher with increasing age. In centenarians, time to surgery >48 hours was independently associated with length of stay (correlation coefficient 3.99 [95% CI: 2.35–5.64; p<0.001]) and anaesthetic risk, based on an ASA score of V, was related to 30-day mortality (ASA score II [OR 0.25, 95% CI: 0.09–0.70; p=0.009] and ASA score III [OR 0.43, 95% CI: 0.19–0.96; p=0.039]). Conclusion Centenarians had different clinical characteristics, management and outcomes. Although centenarians had worse outcomes, nearly 4 out of 5 centenarians were alive one month after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Boixareu¹,

Ojeda-Thies²,

Valtueña³

et al. 2023

CIA

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“…The mortality of hip fractures has been well documented within literature. For similar age-matched groups the literature has reported 30-d and 1-year mortality between 10%-24%[ 5 , 7 - 9 ], rising to 15%-56%[ 10 - 13 ] in centenarians. Recently, Bolton et al [ 14 ] reported the 30-d and 1-year mortality rate in the non-agenarian hip fractures to be 12.4% and 38.1%[ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Survival analysis in nonagenarian patients with non-hip lower limb fractures

Narayana Murthy,

Cheruvu,

Siddiqui

et al. 2023

World J Orthop

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Periprosthetic joint infection (PJI) is a rare but terrible complication in hip and knee arthroplasty, and the use of topical vancomycin powder (VP) has been investigated as a tool to potentially reduce its incidence. However, there remains no consensus on its efficacy. Therefore, the aim of this review is to provide an overview on the application of topical vancomycin in orthopaedic surgery focusing on the recent evidence and results in total joint arthroplasty. Several systematic reviews and meta-analyses on topical VP in hip and knee arthroplasty have been recently published reporting sometimes conflicting results. Apart from all being limited by the quality of the included studies (mostly level III and IV), confounding variables are often included potentially leading to biased conclusions. If taken into consideration the exclusive use of VP in isolation, the available data, although very limited, suggest that it does not reduce the infection rate in routine primary hip and knee arthroplasty. Therefore, we still cannot advise for a routinary application. A properly powered randomized-controlled trial would be necessary to clarify the role of VP in hip and knee arthroplasty. Based on the analysis of the current evidence, the use of topical VP appears to be safe when used locally in terms of systemic adverse reactions, hence, if proven to be effective, it could bring great benefits due to its low cost and accessibility.

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“…Several case reports and numerous news have described successful hip hemiarthroplasty, total hip arthroplasty (THA), and revision THA in patients range 100-112 years (8-10) (Table S1). A couple of retrospective studies have found that the short-term outcomes among centenarians were comparable with those younger cohorts with similar fracture patterns (4,5,11), which suggested that hip arthroplasty is worthwhile to maintain quality of life, and should not be refused solely on account of extreme age or the concern of high in-hospital mortality risk.…”

Section: Discussionmentioning

confidence: 99%

Never too old for hip arthroplasty: a 111-year-old woman walks out of hospital—a case report and literature review

Liu

et al. 2020

Ann Transl Med

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Centenarians population is proliferating, and hip fractures are responsible for more than 10% of all hospital admissions for centenarian patients, which represents a considerable challenge to patients and healthcare providers. Herein, we first report a case of a 111-year-old woman who suffered from a hip fracture and was successfully managed with cemented hemiarthroplasty surgery. In addition, we further reviewed case reports, news, and related studies to address the central points in managing hip fractures in the centenarian population.

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Too Old for Surgery? Outcomes of Hip Fracture Surgery in Centenarians

Cited by 9 publications

References 7 publications

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Survival analysis in nonagenarian patients with non-hip lower limb fractures

Never too old for hip arthroplasty: a 111-year-old woman walks out of hospital—a case report and literature review

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